Kvolik Slavica, Koruga Nenad, Skiljic Sonja
Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.
Department of Anesthesiology and Critical Care, Osijek University Hospital, Osijek, Croatia.
Front Neurol. 2022 Jan 25;12:819613. doi: 10.3389/fneur.2021.819613. eCollection 2021.
Acute pain in neurosurgical patients is an important issue. Opioids are the most used for pain treatment in the neurosurgical ICU. Potential side effects of opioid use such as oversedation, respiratory depression, hypercapnia, worsening intracranial pressure, nausea, and vomiting may be problems and could interfere with neurologic assessment. Consequently, reducing opioids and use of non-opioid analgesics and adjuvants (N-methyl-D-aspartate antagonists, α2 -adrenergic agonists, anticonvulsants, corticosteroids), as well as non-pharmacological therapies were introduced as a part of a multimodal regimen. Local and regional anesthesia is effective in opioid reduction during the early postoperative period. Among non-opioid agents, acetaminophen and non-steroidal anti-inflammatory drugs are used frequently. Adverse events associated with opioid use in neurosurgical patients are discussed. Larger controlled studies are needed to find optimal pain management tailored to neurologically impaired neurosurgical patients.
神经外科患者的急性疼痛是一个重要问题。阿片类药物是神经外科重症监护病房中最常用于疼痛治疗的药物。使用阿片类药物的潜在副作用，如过度镇静、呼吸抑制、高碳酸血症、颅内压恶化、恶心和呕吐，可能会成为问题，并可能干扰神经学评估。因此，减少阿片类药物的使用，并使用非阿片类镇痛药和佐剂（N-甲基-D-天冬氨酸拮抗剂、α2-肾上腺素能激动剂、抗惊厥药、皮质类固醇）以及非药物治疗，被引入作为多模式治疗方案的一部分。局部和区域麻醉在术后早期减少阿片类药物使用方面是有效的。在非阿片类药物中，对乙酰氨基酚和非甾体抗炎药使用频繁。讨论了神经外科患者使用阿片类药物相关的不良事件。需要进行更大规模的对照研究，以找到适合神经功能受损的神经外科患者的最佳疼痛管理方法。
